Anaesthesia Providers Practices on Preoperative Preparation of Emergency Drugs at Kenyatta National Hospital

Abstract

Background: Anaesthesia is associated with critical incidents that a skilled anaesthesia provider must prevent, promptly recognise, and subsequently manage. Emergency drugs need to be readily available to prevent delays in intervening should a critical incident occur. Prefilled syringes of emergency drugs are the recommendation; however, in their absence, anaesthesia providers routinely prepare emergency drugs before starting the operating list in anticipation of any critical incident. Study objective: To determine the anaesthesia providers practices on preoperative preparation of emergency drugs in Kenyatta National Hospital. Study design: This was a prospective longitudinal observational study carried out in KNH main and trauma theatre to observe anaesthesia providers' practices on preoperative preparation of emergency drugs. 395 theatre shifts were observed consecutively. Informed consent was sought from the anaesthesia providers allocated to the shifts observed. The principal investigator and research assistant observed anaesthesia providers allocated to main operating theatres and trauma theatres during the study period at the beginning of their shifts to determine their practices on preoperative preparation of emergency drugs and again upon completion of their surgical lists or end of shifts to observe the usage and fate of the prepared emergency drugs. Results: Anaesthesia providers prepare emergency drugs preoperatively in anticipation of critical incidents. Of the 395 shifts observed, 322 theatre shifts had emergency drugs prepared preoperatively by anaesthesia providers, while 73 did not. The most prepared emergency drugs include adrenaline (90.4%), atropine (78.9%), and ephedrine (34.5%). Others less frequently prepared include succinylcholine and phenylephrine. 87.3% of the pre-drawn drugs not utilised by completion of the shift or list were discarded. Conclusion: The findings of this study indicate that anaesthesia providers in KNH main and trauma theatre routinely prepare emergency drugs in advance at the beginning of their shifts. The type of emergency drugs pre-drawn before the onset of anaesthesia is not standard. Preference of the anaesthesia provider, and type of surgical list, among others, majorly influence it. These drugs are pre-drawn in anticipation of critical incidents; however, when not utilised by the end of the shift, they are discarded, thus contributing to preventable drug